May 2, 2013

SOM instructors recognized for serving the underserved

Morgan McDonald, M.D., left, and Jule West, M.D., talk with patient Freddie Mitchell during his visit to the Downtown Clinic. (Photo by John Russell)

A combination of highly rated clinical skills, a thirst for mentorship and a deep sense of respect for their patients are among the reasons listed in two recent recognitions for a pair of Vanderbilt physicians.

Jule West, M.D., assistant professor of Internal Medicine and her colleague, Morgan McDonald, M.D., assistant professor of Internal Medicine and Pediatrics were both named to the Vanderbilt Academy for Excellence in Teaching this March, and they were recently recognized for “service and education in the community” as part of a benefit dinner for the Vanderbilt University School of Medicine’s Shade Tree Clinic.

Since 2008, West and McDonald have split their time between work as faculty at VUSM, and providing primary care services to the patients at the United Neighborhood Health Services (UNHS) clinics, including most recently, the Downtown Clinic for the homeless.

“I feel special and privileged to sit in the exam room with our patients who trust us, when a lot of society hasn’t treated them well. Many have had the kind of trauma– as children or as adults– that we will never understand,” West said.

Most of the patients seen at the Downtown Clinic (DTC), located at the corner of 8th and Drexel, next to Room in the Inn, have both complex health problems and complex lives. Nearly 4,000 homeless patients were seen there for more than 13,000 clinic visits in 2011. Eighty-eight percent have no insurance at all and almost all patients have some combination of health and mental health concerns including diabetes, high blood pressure, behavioral or substance abuse problems.

Patients can come to the clinic for free or sliding scale services including medical, dental and behavioral health care visits.

Recently, patient Freddie Mitchell came in for help because his medications were making him too sleepy. West and McDonald collaborated to work through Mitchell’s difficult list of health concerns. Then West approached Mitchell, with a hand on his shoulder, explained the proposed solution, and asked him to lend his opinion before changes were made.

It’s typical care at the DTC but it is care that is increasingly difficult for uninsured and underserved patients to find. West and McDonald say the development of collaborative relationships with such patients can be especially difficult, yet rewarding.

“I personally find it inspiring to walk alongside people engaging in tremendous life struggles. I have learned the importance of relationships in health care. The relationship itself has power and healing and you have to go the extra mile to gain their trust to engage in relationship,” McDonald said.

Vanderbilt’s collaborative relationship with UNHS C.E.O. Mary Bufwack, Ph.D., has enabled faculty and students to extend teaching and services to a number of clinics over the years. DTC has served as a model of service-education; with West and McDonald mentoring and precepting a variety of future health care providers there.

“It is gratifying to work with Vanderbilt in bringing this type of training to students and residents.  We know that patients benefit when we can address their many needs as an integrated team.  Our homeless clients particularly benefit from this model with improved care and improved care coordination,” Bufwack said.

West said she and McDonald are grateful to have the chance to work with UNHS’s talented professionals and to have the opportunity to teach at DTC. Robert Miller, M.D., associate professor of Clinical Medicine and co-medical director at the student-run Shade Tree Clinic, said West and McDonald have been ideal choices to expand on the service-learning model that began at Shade Tree.

“Morgan and Jule do more for their patients with less. I believe they are the best examples of community physicians in the Department of Medicine. When the students who started Shade Tree created partnerships with community providers and showed how students and faculty could work in a different model, Vanderbilt recognized the value and invested by contracting with United Neighborhood Health Services for Jule and Morgan to teach in a community setting. They have continued to grow this invaluable teaching experiences for students and residents,” said Miller.

West and McDonald mentor and precept a variety of students and residents at the DTC. They co-direct a fourth-year immersion course for medical students called Community Healthcare: Patients, Populations and Systems. McDonald is the co-course director for the Continuity Clinical Experience that places all medical students in a continuity clinic under the new Curriculum 2.0. West serves as the medical course director for the Vanderbilt Program in Interprofessional Learning (VPIL), where Vanderbilt School of Nursing and Medicine students, Belmont and Lipscomb Pharmacy students, and social work students are part of a weekly clinic experience, two of which take place at DTC each week.

Together West and McDonald also mentor rotations of internal medicine residents, and traditional fourth-year medical students in primary care rotations. Both say the teaching component of what they do is critically important in the training of the next generation of health care providers.

“We are grateful that Vanderbilt sees this as valuable and allows us to do this.

“Here I have the opportunity to model and mentor clinical excellence in a setting of social responsibility and service to the underserved. This is my ideal job.” West said.